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124478 <br />A`oRo®ATE CERTIFICATE OF LIABILITY INSURANCE <br />o 5/18/2017 Yr) <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. <br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on <br />this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). <br />PRODUCER <br />Commercial Lines -(415)541-7900 <br />Wells Fargo Insurance Services USA, Inc. -CA Lic#: OD08408 <br />45 Fremont Street, Suite 800 <br />San Francisco, CA 94105-2259 <br />CONTACT Certificate Team <br />NAME: <br />acNue , 415-541-7900 Arc No: <br />E-MAIL certificates wellsfa o.com <br />ADDRESS: @ nJ <br />INSURER(S) AFFORDING COVERAGE NAIC# <br />INsuRERA: Great Northern Insurance Company 20303 <br />INSURED <br />BLX Group, LLC <br />INSURER B; Federal Insurance Company 20281 <br />INSURER C : <br />777 South Figueroa Street, Suite 3200 <br />INSURER D: <br />INSURER E: <br />GENT AGGREGATE LIMIT APPLIES PER: <br />X POLICY ❑PRO -ECT FLOC <br />J <br />X OTHERIntl. Conbaclors <br />Los Angeles, CA 90017 <br />INSURER F: <br />COVERAGES CERTIFICATE NUMBER: 11786389 REVISION NUMBER: See below <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INTR <br />TYPE OF INSURANCE <br />AUULSUBR <br />20 Civic Center Plaza M-25 <br />POLICY NUMBER <br />POLICY EFF <br />(MMMDNYYYI <br />POLICY EXP <br />IMMIDDIYYYY)LIMITS <br />A <br />X COMMERCIALGENERAL LIABILITY <br />CLAIMS -MADE I X I OCCUR <br />X Host Uquor lnrAuded <br />97' <br />35821151 <br />06/01/2017 <br />06/01/2018 <br />EACH OCCURRENCE S 1,000,000 <br />DAMAGETO ED <br />PREMISES(Ea occurrence $ 1,000,000 <br />MED EXP (Any one person) S 10,000 <br />PERSONAL S ADV INJURY 5 1,000,000 <br />GENT AGGREGATE LIMIT APPLIES PER: <br />X POLICY ❑PRO -ECT FLOC <br />J <br />X OTHERIntl. Conbaclors <br />GENERALAGGREGATE $ 2,000,000 <br />PRODUCTS -COMP/OPAGO S incl in Gen Agg <br />$ <br />B <br />AUTOMOBILE uaewrY74996569 <br />ANY AUTO <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />X HIREDX NON -OWNED <br />AUTOS ONLY AUTOS ONLY <br />74996569 <br />06/01/2017 <br />06/01/2018 <br />COMBINED SINGLE LIMIT <br />Ea accident 1,00Qg00 <br />BODILY I NJURY(Per person) $ <br />BODILY INJURY (Per accident) 5 <br />PROPERTY DAMAGE S <br />Per accident <br />$ <br />B <br />X UMBRELLALIAB X OCCUR <br />EXCESS LIAB CLAIMS -MADE <br />DED RETENTION$ <br />79820023 <br />06/01/2017 <br />06/01/2018 <br />EACH OCCURRENCE 5 5,000,000 <br />AGGREGATE $ 5,000,000 <br />S <br />WORKERS COMPENSATION <br />ANDEMPLOYER3'LIABILITY YIN <br />ANYPROPRIETORIPARTNERIEXECUTIVE <br />OFFICERIMEMBEREXCLUDED? <br />(Mandatory in NH) <br />Pyes. describe under <br />DESCRIPTION OF OPERATIONS below <br />NIA <br />PER OTH- <br />STATUTE ER <br />E.L. EACH ACCIDENT $ <br />E L. DISEASE - EA EMPLOYEE $ <br />E. L. DISEASE -POLICY LIMIT S <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be stacked if more space is required) <br />The Certificate Holder is named as Additional Insured as it relates to general & auto liability in accordance with the terms and conditions of the policy. <br />CERTIFICATE HOLDER CANCELLATION <br />City of Santa Ana <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />20 Civic Center Plaza M-25 <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />Santa Ana CA 92701 <br />AUTHORIZED REPRESENTATIVE <br />97' <br />ACORD 25 (2016103) <br />The ACORD name and logo are registered marks of ACORD ©1988-2015 ACORD CORPORATION. All rights reserved. <br />2N ji� CL -VD g� ��'&ILo r is i W d <br />